Not long ago, I cared for a middle-aged man I’ll call Jim, who was generally healthy but had recently started to feel sluggish. One of his friends told him to try a hormone supplement. After Jim saw on social media that Robert F. Kennedy, Jr., the Trump Administration’s Secretary of Health and Human Services, had endorsed supplements as a part of an “anti-aging” regimen, he ordered one from a telehealth company. A few months later, he noticed swelling and pain in his calf. ChatGPT warned him that he might have a blood clot. I met Jim for the first time in the emergency room. An ultrasound revealed a blockage in a leg vein, which could cause serious problems if it travelled to his lungs. He stopped the supplement and started a blood thinner.
What struck me about Jim’s case was that, until the moment he limped into the hospital where I work, his journey had taken place entirely outside of the traditional health-care system. He found a remedy through word of mouth; social media and the Make America Healthy Again movement lent credibility to it; and a direct-to-consumer company supplied it. A.I. diagnosed his blood clot—I only confirmed it. Jim hadn’t been seen by a doctor in years.
New Yorker writers reflect on the year’s highs and lows.

For much of the past century, doctors had a near-monopoly on knowledge about and the provision of medical care. Patients had little choice but to turn to doctors, and doctors had little need to justify their gatekeeping role. But, today, many groups—A.I. startups, wellness influencers, longevity entrepreneurs, MAHA acolytes—are vying for medical authority, often by chipping away at that of doctors. In her best-selling book, “Good Energy,” Casey Means, Donald Trump’s nominee for Surgeon General, wrote that the most meaningful days of her life “came from ignoring a team of doctors,” who had recommended that her mother try aggressive end-of-life cancer care. Means, who trained as a surgeon before turning to alternative medicine, suggested that her mother’s doctors were biased by financial interests. In February, Bill Gates said on “The Tonight Show” that A.I. will make sophisticated medical advice—the kind that has been limited by the availability of skilled practitioners—costless and commonplace over the next decade. Humans, he said, will no longer be needed “for most things.” (The New Yorker’s parent company, Condé Nast, has partnerships with several A.I. companies, including OpenAI.)
As it is, a recent poll found that about half of young people believe that individuals who do their own research can know as much as a doctor. Nearly forty per cent say they’ve followed advice seen on social media instead of a medical provider’s—even though around half of the top hundred trending mental-health videos on TikTok contain misleading or inaccurate information, according to an investigation by the Guardian. In the U.S., nearly four in ten parents identify as supporters of the MAHA movement. Meanwhile, according to a Gallup survey, the trust Americans have in doctors has fallen fourteen points since 2021, and now sits at its lowest level in decades. In 2025, a doctor at a clinic is just one purveyor of health care in an increasingly competitive market.
Historically, medicine’s power rested on a specific kind of cultural authority—the ability to determine not only what diseases exist, who has them, and what to do about it, but also what counts as evidence or truth. In “The Social Transformation of American Medicine,” first published in 1983, the Princeton sociologist Paul Starr describes two pillars of professional authority: legitimacy and dependency. Legitimacy provides a basis for why people accept influence over their lives; dependency refers to the harm they’re likely to face if they don’t accept it. Starr argues that authority is, paradoxically, characterized by the power to compel or persuade—but it is undermined by the need to resort to either. If you have to talk people into believing that you’re right, it’s because they don’t think that you are.
Medicine is undergoing a kind of unbundling. Specialized services can now be accessed à la carte from many sources other than doctors—even if some are bad for our health. The upshot is that medicine can no longer take its cultural authority for granted. In today’s fractured and fractious health-care system, doctors must convince patients of the value of their expertise, and at times they must outcompete other kinds of providers. We may need to accept that we are no longer the high priests of health care. Perhaps, instead, it’s time to think of ourselves as what we have always been: healers.
The medical profession wasn’t always powerful. For decades after the nation’s founding, doctors had competition from homeopaths, herbalists, apothecaries, midwives, and religious healers—not to mention mothers. Some doctors worked second jobs. Benjamin Rush, a physician and a Founding Father, encouraged students at the country’s first medical school, the University of Pennsylvania, to cultivate a farm, so that they could eat even when business was bad. Otherwise, he told them, you might harbor “an impious wish for the prevalence of sickness in your neighbourhood.”
In the nineteenth century, doctors started to consolidate their authority by standardizing, and encouraging, medical education. Most states passed medical-licensing laws, although they were unevenly enforced. But during the populist era that followed the election of Andrew Jackson—one of Trump’s favorite Presidents—many states repealed licensing requirements altogether, amid a surge in suspicion of élites and expertise. Not until the twentieth century did medical schools, medical societies, and medical boards—three types of institutions that can buttress a profession—coalesce to give doctors a new level of influence.
Some of today’s challenges to medical authority, including political shifts and technological changes, began outside the medical field. But others seem like reactions to long-standing shortcomings. Tens of millions of Americans don’t have a primary-care doctor, and, in much of the country, wait times to see a physician reached new highs this year. More than half of U.S. counties don’t have a psychiatrist. Many people wish that their medical providers spent more time trying to understand them. Meanwhile, medical errors are estimated to harm hundreds of thousands of Americans each year.
The multibillion-dollar field of menopause care, which has historically been understudied and underfunded, hints at what’s happening to health care as a whole. There has been an explosion of investment: between 2019 and 2024, venture-capital funding for women’s health more than tripled, and women now have access to care that they previously didn’t have. But these funds are not necessarily flowing to medical professionals; in some cases, so-called menopause influencers are exploiting a “menopause Gold Rush.” “The slowly dawning realisation that these women might be slightly underserved . . . has unfortunately coincided with the high-water mark of aggressive capitalism,” the author Viv Groskop argued in the Guardian. The BBC journalist Kirsty Wark has warned that many women are promised relief from “debilitating symptoms if they buy specially branded supplements, teas, and even pyjamas.”
Worthwhile efforts to make medicine more convenient and accessible can sometimes lead to care that is diluted and extractive—partly because businesses can be untethered from the ethics that guide the medical profession. For many health-care startups, selling pills and products is tidier than the comprehensive forms of care offered at traditional medical practices; writing prescriptions is more scalable than building relationships. Last year, Cerebral, which called itself the fastest-growing mental-health company in history, agreed to pay millions of dollars in fines for overprescribing addictive A.D.H.D. medications. Last month, following a Wall Street Journal investigation, executives at the mental-health startup Done Global were found guilty of aggressively pushing Adderall. At the trial, one clinician testified that she was “just stamping” prescriptions without conducting follow-up patient visits. According to a former executive, the C.E.O. had encouraged employees to “bend laws” and told them, “Whoever is the first person to get arrested, I’ll buy you a Tesla.”
Technological fixes for medicine’s weaknesses carry similar possibilities and pitfalls. A.I. increasingly seems capable of solving complex medical cases; the United Kingdom has announced plans to roll out a “ChatGPT for the NHS,” intended to serve as a first point of contact for patients in need of primary care. In the U.S., the startup Doctronic offers free online visits with an A.I. clinician, with the option to see a human physician afterward—for a fee. Doctors have long been gatekeepers to medical technology, but now technology could serve as a gatekeeper to doctors.
Algorithmic health care comes with its own perils. Many people say that they’ve received incorrect medical advice from chatbots, and that it’s difficult for them to tell whether A.I.-generated health information is wrong. New research suggests that when chatbots are given false information they readily repeat and expand upon it. In a presentation to regulators, the head of the American Psychological Association warned that chatbots “masquerading” as therapists can be “antithetical” to responsible care. Several lawsuits allege that OpenAI’s models contributed to suicides among young people. (In one case, OpenAI denied the allegations in court filings.)
Earlier this year, a judge allowed a class-action lawsuit against UnitedHealthcare to move forward. According to the health-news site STAT, Medicare patients were forced out of rehabilitation facilities, or had to spend down their savings to remain in care, because an A.I. tool said they ought to have recovered by then. A subsidiary of the company reportedly set goals to closely align patients’ rehab stays with the A.I.’s output. (UnitedHealthcare denied the allegations, telling STAT that the tool wasn’t used to make coverage decisions.) One woman, Megan Bent, recounted the story of her father, who was in a rehab facility after surgery to remove a cancerous lesion from his brain. The A.I. tool said that he needed only a few weeks to recover; his neurosurgeon said three months. Bent won two appeals on behalf of her father, but, after a third, UnitedHealthcare said it would not cover his care. He went home with meningitis, returned to the hospital a few hours later, and died.
Starr, the Princeton sociologist, correctly predicted that corporatization would remake American health care, and that physicians would lose autonomy and authority. But what really surprised him, he told me recently, is the rise of Robert F. Kennedy, Jr., and what he called a “radical shift” in federal science policy. In 2025, according to the Times, the Trump Administration awarded grants to thousands fewer research projects than usual, which has affected virtually every aspect of medicine. This year, the Department of Health and Human Services purged thousands of employees and weakened government programs dedicated to tobacco control, environmental safety, injury prevention, and reproductive health. “This is part of an effort by one set of élites to use populist appeals to undermine another set of élites,” Starr told me. “I didn’t expect things to move this far, this fast.”
It’s not just money that’s being reallocated—it’s trust. When Trump tells pregnant women to “fight like hell” not to take Tylenol, citing a disputed link to autism, or when Kennedy remakes the country’s most important vaccine-advisory committee after suggesting that previous members were corrupt, they are signalling that doctors cannot be trusted as sources of truth. “The fact that MAHA is so parasitic on MAGA suggests that what’s happening in health is really a subset of a larger development,” Sophia Rosenfeld, a history professor at the University of Pennsylvania and author of “Democracy and Truth,” told me. “All of these bulwarks that have helped us organize the transmission of knowledge are in crisis.” According to a recent KFF-Washington Post poll, many parents aren’t sure whether Kennedy’s claims about vaccines are true, and about half lack confidence that federal health agencies can insure the safety of vaccines. When displacing existing sources of authority, uncertainty is a feature, not a bug.
The medical profession of the twentieth century was a hegemon; today, it is a regional power. When a hegemon loses status, it can take a few paths. It can aim for restoration—bringing back the empire—which in this case would probably focus on gatekeeping. It can retreat, which might mean abdicating medicine’s broad public role, perhaps in favor of a narrow focus on earnings and technical skills. The last—and, in my view, the best—path is reinvention. Doctors can remake their profession by embracing the multi-polar medical landscape they now inhabit, and by acting as a kind of system stabilizer: working with other powers to help shape rules, norms, and relationships. A superpower may act as though it can stand alone, but middle powers know the value of diplomacy and coalition-building.
Reinventing the medical profession will require greater engagement with the world outside of hospitals and clinics. Many physicians are taking to social media; a cadre of “TikTok Docs” have amassed millions of followers with accessible and engaging videos. A growing number of doctors seem interested in leading health-care companies themselves or in running for office; in February, an advocacy organization set out to try to get a hundred physicians elected by 2030. Diplomacy also requires a willingness to stand in opposition to others. This year, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and other medical organizations issued recommendations that conflicted with those of the federal government. A few weeks ago, a dozen former F.D.A. officials, all of them physicians, wrote that they were “deeply concerned” about “the latest in a series of troubling changes”: the agency planned to make the approval of new vaccines more difficult. Such a move, they wrote, “could diminish both the FDA’s strength and Americans’ health and safety.”
Medical school is a place not only for technical instruction but also for moral formation; becoming a doctor means adopting a way of thinking and also a way of behaving. “The thing that unites Hippocrates, and nineteenth-century physicians, and physicians today, is the thing that we’re trying to do: help people feel better,” Richard Baron, an internist and geriatrician who until recently led the American Board of Internal Medicine, told me. “How we do it changes all the time. What we do never does.” That is not to say that doctors never err—they do, sometimes egregiously—but a thriving profession will set norms, correct itself, and defend against unrestrained commercialization and exploitation. Even today, in a moment of pitched cynicism, the public seems to appreciate this. Americans of all backgrounds and politics still overwhelmingly trust their own doctors.
In recent years, as alternative sources of medical authority have proliferated, some doctors have grown frustrated with how their jobs have changed. Pediatricians spend more time persuading parents to get children vaccinated; oncologists counsel patients when full-body MRIs, which are not usually recommended by doctors, raise false alarms. Sometimes I’m irritated that I have to steer someone away from a trending procedure, or convince them that they need an antibiotic. Doctors tend to see these conversations as distractions—a detour from “real medicine.” But we ought to understand them as increasingly important and, indeed, central to our jobs. Today, the doctor’s perspective must replace the doctor’s orders.
When I met Jim, my first inclination was to lecture him about the risks of supplements, and I caught myself adopting an I-told-you-so tone that often characterizes health communication. As he relayed his story, though, I grew more curious than critical. In spite of myself, I started to employ the most basic skill in medicine, and, possibly, in human interaction: I tried to look at things from his perspective. If I were in his position, I told him, I might have done what he did. During the visit, I also noticed that his blood-sugar level was elevated, a potential sign of diabetes. Reassuringly, he agreed to see a doctor. He even asked if I’d care for him. (Alas, I only see hospitalized patients.) In a world of distributed authority, a doctor’s every conversation is a chance to help patients see the value of science and medicine in their lives.
This year, I’ve found myself considering an aphorism I first heard in medical school: cure sometimes, relieve often, comfort always. The phrase is sometimes attributed to Hippocrates, but probably comes from Edward Livingston Trudeau, a physician who founded a nineteenth-century tuberculosis sanitarium in upstate New York, when antibiotics did not exist. As medicine has grown more powerful, it has focussed increasingly on cures over comfort. But it doesn’t have to be this way. “Medicine isn’t getting its old status back,” Baron said. “And why should the average person care about whether doctors have a privileged position, anyway? What they care about is: Who is going to help me when I need help?”
Recently, I spoke with an older woman I’ll call Margaret, who for decades had struggled with alcohol and often thought about quitting. About a year ago, her primary-care doctor helped her get treatment. “She was the one who really called me out,” Margaret said. One evening, she started experiencing symptoms of alcohol withdrawal—anxiety, tremors, a racing heart rate—and messaged her doctor, who responded immediately. “She said, I’m here for you. I’ll meet you at the E.R. if you want to come in.” Margaret decided to stay home, and the doctor spent much of the evening checking in. “She’s the reason I got through that initial withdrawal,” Margaret told me. “She’s the reason I’m sober.” Margaret’s doctor knew what Margaret needed, showed up when it mattered, and shepherded her through the most difficult moments. That’s what people have always wanted from their doctors. It’s what they always will. ♦












